Supply chains for time-sensitive products, and, in particular, for perishable products, pose specific and unique challenges. By definition, a perishable product has a limited lifetime during which it can be used, after which it should be discarded (Federgruen, Prastacos, and Zipkin (1986)). In this dissertation, I contribute to the analysis, design, and management of supply chain networks for perishable products with applications to healthcare. Specifically, I construct generalized network frameworks to capture perishable product supply chains in healthcare operating under either centralized or decentralized decision-making behavior. The dissertation is motivated by applications ranging from blood supply chains to pharmaceuticals, such as vaccines and medicines. The novelty of the modeling and computational framework includes the use of arc multipliers to capture the perishability of the healthcare product(s), along with waste management costs, and risk. The first part of the dissertation consists of a literature review of perishable product supply chains with a focus on healthcare along with an overview of the relevant methodologies. The second part of the dissertation formulates supply chains in healthcare operating under centralized decision-making behavior. In this part, I focus on both the operations management of and the sustainable design of blood supply chains and construct models for regionalized blood banking systems as belonging to the Red Cross. The third part of the dissertation considers competitive behavior, with a focus on the pharmaceutical industry. I construct an oligopoly supply chain network model, with differentiated brands to capture the competition among producers of substitutable drugs using game theory and variational inequality theory. Furthermore, using a case study based on real-world scenarios of a highly popular cholesterol-reducing branded drug, the impact of patent rights expiration of that brand is explored which coincides the time when its equivalent generic emerges into the markets. The calculated results are then compared to the observations from the real-word problem. Finally, the projected dynamical system formulation of the pharmaceutical network oligopoly model is derived. This dissertation is based on the following papers: Nagurney, Masoumi, and Yu (2012), Nagurney and Masoumi (2012), and Masoumi, Yu, and Nagurney (2012) as well as additional results and conclusions.

Acute respiratory tract infection (ARI) is the most common reason for outpatient medical visits in the United States, and frequently results in treatment with an antibiotic. Most ARIs have a viral etiology, thus antibiotic therapy will have little clinical benefit in these cases. It is estimated as much as one-half of all antibiotic utilization for ARI in outpatient settings is inappropriate. Importantly, this misuse is thought to be the primary driver of antibiotic resistance development among bacteria. Antibiotic resistant infections cause an estimated 2 million illnesses and 23,000 deaths annually in the United States, and associated costs exceed $30 billion. Despite our current understanding of relevant predictors of appropriate antibiotic use, less is known regarding seasonality. This dissertation explores effects of seasonality on antibiotic prescribing in three aspects: 1) seasonal variation in appropriateness of prescribing, and antibiotics prescribed among common ARIs; 2) specific predictors of observed seasonal variation in prescribing practices; and 3) implications of seasonality for guideline concordance & quality of care. Findings generated herein, could help inform interventions designed to promote more judicious use of antibiotics in healthcare.

Recent marketplace realities and trends have forced health care institutions to adopt strategic orientations that stress a customer focus. Central to such strategic orientations is the effective utilization of service quality practices and philosophies. Toward that end, this research offers health care institutions an affordable methodology. A real-life application of the rapid assessment methodology (RAM) in a health care operational setting is presented. Finally, a framework to guide the implementation of the RAM methodology is outlined and explored.

No description available.

No description available.

No description available.

This thesis is centered around Black maternal health disparities and the impact of Roe v Wade being overturned on the future of Black maternal health. I start off by first looking at the facts of maternal health disparities and how Black women are dying at a higher rate than their White counterparts. Then I draw on social determinants of health and how systemic racism plays a role in the health disparities we see today. I bring in literature that discusses different frameworks created to reduce the maternal health disparities gap. I use the literature to argue that more initiatives need to be done since the gap is still increasing. My intention for this thesis is to bring light to some solutions that may help decrease the maternal health disparities and highlight how Roe v Wade being overturned can cause a larger harm in Black maternal health. / Urban Bioethics

No description available.

No description available.

In this dissertation I explore the cultures of death and dying in medical institutions, hospices and funeral work. I argue that not only are there competing cultures of death and dying in American society, but within these institutions that produce tension and conflict, sometimes among the workers, other times between the workers and those they serve, and other times between the institution and outside organizations. Medical institutions, by medicalizing death and dying, constructed a “death as enemy” orientation in which doctors fight death with the use of medical technology, practice detached concern from their patients, and marginalize religion and spirituality. On the other hand, a “suffering as enemy” orientation has also emerged, primarily in the form of palliative medicine, in which needless suffering is considered worse than death, therefore life-saving technology is removed, doctors empathize with patients and families, and spirituality is incorporated. Hospice started as a social movement to change how dying patients were treated at the end of life, addressing patients' physical, spiritual and emotional pain. However, the bureaucratization of hospice, particularly the Medicare Hospice Benefit, has led to a compromise of the social movement's ideals and these competing orientations shape how hospice workers, particularly nurses and social workers, express frustrations with their work. Funeral directors assert their jurisdictional claims of the right to handle the corpse and assuage the grief of the bereaved, through embalming, informal grief counseling and the funeral performance, but funeral directors encounter resistance from large funeral corporations and the funeral societies. Large corporations centralize embalming, turning the corpse from a craft to a product, recruit other professionals to practice grief counseling, and sell standardized funeral packages. Funeral societies challenge the necessity of embalming and funeral directors' expertise in grief counseling, and focusing on the value of simple, dignified and affordable funerals. I conclude this dissertation by showing how orientations toward death and dying vary in American society and these institutions because of tension between experts who espouse a particular orientation and challenges from within and outside these institutions.